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Antimicrobial Agents and Chemotherapy, April 2000, p. 879-884, Vol. 44, No. 4
Division of Infectious Diseases, Roger
Williams Medical Center, Rhode Island Hospital, Brown University,
Providence, Rhode Island
Received 8 April 1999/Returned for modification 18 September
1999/Accepted 10 January 2000
To demonstrate the impact of the pharmacokinetics of gatifloxacin
(GA) relative to those of ciprofloxacin (CI) on the antimicrobial effect (AME), the killing and regrowth kinetics of two differentially susceptible clinical isolates each of Staphylococcus
aureus, Escherichia coli, and Klebsiella
pneumoniae were studied. With each organism, a series of
monoexponential pharmacokinetic profiles of GA (half-life [t1/2], 7 h) and CI
(t1/2 = 4 h) were simulated to mimic
different single doses of GA and two 12-h doses of CI. The respective
eightfold ranges of the ratios of the area under the concentration-time curve (AUC) to the MIC were 58 to 466 and 116 to 932 (µg · h/ml)/(µg/ml). The species- and strain-independent linear
relationships observed between the intensity of AME
(IE) and log AUC/MIC were not superimposed for
GA and CI (r2 = 0.99 in both cases). The
predicted AUC/MIC ratio for GA that might be equivalent to a clinically
relevant AUC/MIC breakpoint for CI was estimated to be 102 rather than
125 (µg · h/ml)/(µg/ml). The respective MIC breakpoints were
0.32 µg/ml (for a 400-mg dose of GA) and 0.18 µg/ml (for two 500-mg
doses of CI). On the basis of the IE-log
AUC/MIC relationships, equiefficient 24-h doses (D24hs) of GA and CI were calculated for
hypothetical strains of S. aureus, E. coli, and
K. pneumoniae for which the MICs were equal to the MICs at
which 50% of isolates are inhibited. To provide an "acceptable"
IE equal to 200 (log CFU/ml) · h, i.e.,
the IE provided by AUC/MIC of 125 (µg
· h/ml)/(µg/ml) for ciprofloxacin, the
D24hs of GA for all three organisms were much
lower (115, 30, and 60 mg) than the clinically proposed 400-mg dose.
Although the usual dose of CI (two doses of 500 mg) would be in excess for E. coli and K. pneumoniae
(D24h = two doses of 40 mg and two doses
of 115 mg, respectively), even the highest clinical dose of CI (two
doses of 750 mg) might be insufficient for S. aureus (D24h, > two doses of 1,000 mg). The method of
generalization of data obtained with specific organisms to other
representatives of the same species described in the present report
might be useful for prediction of the AMEs of new quinolones.
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Comparative Pharmacodynamics of Gatifloxacin and
Ciprofloxacin in an In Vitro Dynamic Model: Prediction of
Equiefficient Doses and the Breakpoints of the Area under the
Curve/MIC Ratio
and
*
Corresponding author. Present address: Department of
Pharmacokinetics, Centre for Science & Technology
LekBioTech, 8 Nauchny proezd, Moscow, 117246 Russia. Phone:
7 (095) 332-3435. Fax: 7 (095) 332-6307. E-mail:
firsov{at}dol.ru.
Present address: Mount Auburn Hospital, Cambridge MA, 02138.
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